Tuesday, May 29, 2007

Government alcohol policy has long been a mystery to me. On the one hand the production of alcohol products is strictly regulated, and very effectively so. On the other, alcohol supply and marketing is a virtual free for all, wild west-style capitalism, unregulated, reckless, dangerous and with disastrous consequences for all to see. Consider:

Alcohol products/brands are free to aggressively advertise to children and young people through multi billion pound sport sponsorship, including alcohol brands on children's replica sports wear. Not to mention the screamingly stupid rules that allow alcohol brands to sponsor F1 and other high speed driving events (just think about that...).

The development of alcohol products, including brightly coloured sweet 'alco-pops' that are clearly developed for, and marketed at the youth market.

The almost complete non-enforcement of laws prohibiting the serving of alcohol to people who appear intoxicated.

The bizarre exemption of alcohol products from having to put ingredient listings on packaging - unique amongst all foods and beverages.

After waiting a shameful 5 years for the alcohol strategy promised early in the life of the labour Government, it finally turns up full of good intentions but entirely lacking teeth or the political will to put said good intentions into action (see above bullets) and has demonstrably failed with alcohol related harms continuing to rise.

non-sensible alcohol marketing

The disgrace that is the UK Government's policy position on alcohol marketing made a small belated step towards some sort of redemption this week with the announcement that alcoholic drinks will carry health warnings, alcohol content as measured in units, a link to the (industry produced and funded) drinkaware website, and safe drinking limits measured in units, from the end of 2008. It should however be noted that the scheme is voluntary and a number of massive alcohol companies have apparently refused to sign up including Scottish & Newcastle, Bacardi, Carlsberg and Diageo which owns Guinness, Blossom Hill, Baileys and Smirnoff.

The news is undoubtedly a positive step, but the anomaly of alcohol's health warning exemption has been an ongoing mystery for those in the public health field for decades, especially when we consider that alcohol is the second most deadly drug on earth (after tobacco), responsible for an estimated 20,000+ premature deaths a year in the UK alone, not forgetting the growing epidemic of binge drinking related violence and social disorder, and alcohol's role in:

65% of suicide attempts

76,000 facial injuries a year

23% of child neglect calls to national helplines

39% of fires

15% of drownings

Yet, alcohol has, for some years, been the only legal drug to not have to put health warnings on its packaging. The more you think about it the more astonishing it appears. And it's not as if this issue has suddenly cropped up either. It's been knocking about at a high level at least as far back as the 1980's, during which time the previous Government's attitude was just as recklessly negligent as the current one has been (until this week. sort of). I'm proud to say Transform have been campaigning on this issue since 1997, so I have a bulging file of correspondence to draw upon. The House of Commons library research services were kind enough to inform us back in June 1997 that:

The problems of alcohol misuse, particularly among the young, were the subject of a Ministerial working group set up in November 1987. Notably no mention was made of the use of health warnings when the group reported in January next year.

In June 1988 Tony Banks MP introduced a Ten Minute Rule Bill to require health warnings to be shown on alcohol labelling and in licensed premises. His proposal did not receive Government support, or the backing of his party.

Alcohol Concern's unambiguously titled paper 'Warning: Alcohol Can Damage Your Health', published in 1991 suggested that, at the very least, there should be voluntary agreement by the drinks industry to show, on all packaging, the number of units of alcohol contained, either in the whole can/bottle, or in an average glass of its contents, and they support the introduction of health warnings similar to those used now in the United States.

Health warnings on alcohol have been advocated by The British Medical Association since 1986. In 1995 a BMA publication: 'Guidelines on sensible drinking' recommended that heath warning against excessive alcohol should also be incorporated in advertisements, and alcohol products should specify the exact number of units.

Given this support seems reasonable to ask what the hold up has been. Changing the labels seems so obvious , uncontroversial and easy to do. So who exactly has been against this plan and what sort of excuses has the Government has been providing for delaying ten years before implementing it?

Well, in a response to a letter from Transform asking why Alcohol products didn't carry health warnings and unit content dated 1st of July 1997, a tad under ten years ago, and just a couple of months after the new government was elected , we received the following response from the Department of Health:

The Government believes that if alcohol is drunk in sensible amounts and in appropriate situations it is not likely to be harmful to a person's health. Therefore, we do not consider it appropriate to display on alcohol containers the health warnings displayed on cigarette packets, although we will keep the matter under review.

The alcoholic strength by volume of a drink must, by law, be shown on its label. However, the Government is working with the drinks industry to produce an agreed format for providing information about the number of units of alcohol in a container at the point of sale. This will help consumers keep a check on the amount of alcohol they drink.

This preposterous nonsense begged a whole series of secondary questions and issues:(we recieved other letters that contained the exact same wording)

Firstly - ANY DRUG if consumed in 'sensible amounts and in the appropriate situations' ..is 'not likely to be harmful to a persons health', including , for example, heroin and cocaine. But...

Secondly - that's really not the point is it, since - obviously- the aim of health warnings is to prevent people consuming non-sensible amounts in non-appropriate situations, something that evidently happens all the time with alcohol. In other words, to make the distinction between use and abuse or, if you prefer, non-problematic and problematic use. Its like arguing that speeding warnings aren't necessary because its safe if you drive under the speed limit.

Thirdly - if you are giving advice in public education messages about sensible drinking in units, then people need to see units on alcohol products: providing alcohol strength and drink volume on the packaging and leaving drinkers to calculate unit content for themselves is obviously not good enough. Nor is providing units at point of sale - they need to be on the packet. You legislate it - it happens. No one will complain; not drinkers, not alcohol concern, not the BMA. No one. Except......the drinks industry.

And this is where it all becomes clear. The only group to object to this obviously sensible and easy to implement measure has historically been the drinks industry. And the reason is obvious; they felt their profits would be under threat. To this end have wielded all their considerable financial, political and lobbying might to prevent health warnings being placed on the drugs they sell, and to prevent people knowing how much of the drug they are consuming. Their concern is profit not public health and we should not be under any illusions about this fact; anything that reduces consumption and profit will be resisted.

So whilst we should celebrate this small victory for common sense we should also use it to point a critical spotlight on Government thinking on drug policy. What sort of political culture is operating that allowed the Government to succumb to industry pressure for so long, whilst problematic drinking was becoming an ever more serious public health and criminal justice issue? In numerous respects they still are succumbing. It is scandalous and should be profoundly worrying for everyone in the drug policy field.

It is a particular worry for those in drug policy reform as its sets a spectacularly bad precedent for future regulatory systems for other drugs in a post prohibition world. For reformers, however, it is easy to be consistent on this issue; we support appropriate evidence based regulation to reduce harm from the production supply and use of all drugs. For illegal drugs this means bringing them within and appropriate legal framework, and for legal drugs, making sure existing regulation is effective and reforming it where appropriate - the goal is the same: minimising harm to users and the wider comunity whilst maximising personal and social wellbeing.

Finally it is worth asking why this change regards labelling has happened now. I suspect that it is all about PR both for the Government and the industry. For the Government they want to be able to say they have 'done something' on alcohol policy - which will be coming under the spotlight as we approach the publication of the new, revised, alcohol strategy (it's a trick familiar to students of illicit drug politics; if all the policy outcomes are a total disaster, just announce some new process stuff - evidence of effectiveness not required). For the industry its similarly all about PR - 'look how responsible we are' they will now be able to claim, 'we listen to the critics, doctors and public health experts', and 'we are genuinely concerned about problem drinking'. No; 30% of drinkers consume 80% of alcohol; this is industry is built on problem drinkers, its biggest earner. On this issue, I must confess, I am beyond cynicism. When I see football team replica kit babygrows with beer brands on them I can't but feel that not only should the industry never be trusted, but also that Government policy on alcohol is totally divorced from ethics and common sense.

Theres more to say on all this but it'll have to wait - rant over for now..

Monday, May 28, 2007

The following article, in a slightly edited form, appears in this month's druglink magazine.

Swedish massage

The perception that low drug use levels in Sweden are a direct result of the country’s tough anti-drugs policy is finding considerable traction in the UK. But, argues Steve Rolles, it is both simplistic and misleading.

Ian Duncan Smith is flagging up the success of Sweden’s drug policy in his new in his role as chairman of the Social Policy Review Group, currently overhauling Tory drug policy in the run up to the next General Election. David Cameron visited the country in February in an attempt to distance himself from his days of cannabis smoking. In the words of the Daily Mail he “praised the tougher approach in Sweden, which does not distinguish between cannabis and harder drugs such as heroin, and practices a zero-tolerance policy.”

In September last year the UN Office of Drugs and Crime produced a report titled 'Sweden's successful drug policy: a review of the evidence'. Launching the document, UNODC Director Antonio Costa repeated his catch phrase that 'societies have the drug problem that they deserve', noting specifically that “in the case of Sweden, the clear association between a restrictive drug policy and low levels of drug use, is striking”.

Sweden's 'successful' policy closely follows, in both letter and spirit, that espoused by the UNODC. Because Sweden has comparatively low European levels of drug use it is perhaps unsurprising that the UN’s drugs office chooses to proclaim the country as a model of good practice, especially given the backdrop of rising drug use globally. Sweden, perhaps not coincidentally, is the UNODC's third largest state funder (nine per cent) after the US (13 per cent) and Italy (11 per cent)*, and has the clearly stated and unambiguous aspiration to a 'drug free society'. This manifests in its tough zero-tolerance approach involving heavy handed policing, the widespread rejection of harm reduction principles, and a focus on coerced abstinence-based treatment.

However, by putting the emphasis so heavily on prevalence success, the UNODC conveniently brushes over some of the less positive aspects of Sweden’s drug policies. According to the country’s nascent user movement, the aversion to harm reduction (shared with the UNODC but notably not the WHO, and UNAIDS) has contributed to Sweden's drug death figures doubling from around 200 to 400 since 1990, placing it high in the Euro rankings. Problematic drug use has also almost doubled since 1980 to a level hovering around the European average.

Furthermore, Costa's suggestion that there is a obvious causal relationship between prevalence and UNODC-style drug control policy appears unsustainable. Various countries have comparable or lower levels of drug use than Sweden but have very different drug policies. Greece, for example, (according to the EMCDDA), has the lowest level of drug use in Europe but spends approximately one-fiftieth on per capita drug-related expenditure that Sweden does. Holland, also has well below the European average drug use, spends more than Sweden per capita, but has a tolerant / harm reduction-led policy that is the polar opposite of the Sweden UNODC model. Conversely, another repressively oriented country - third in the Euro drug-related expenditure tables - is the UK, which sits at the top of most European drug use prevalence tables. We have yet to see a UN report titled 'The UK’s unsuccessful drug policy: a review of the evidence', indeed if the UK Government buys into Costa's analysis they must be wondering what they have done to 'deserve' our high prevalence rates.

The alternative theory, one not based on the UNODC's public relations crisis and overtly political prerogatives, would be that levels of drug use are determined by a complex and highly localised interplay of multiple social, cultural, economic and demographic variables, and that government drug policies, specifically enforcement and prevention efforts, have, at best, only marginal impacts.

Dr Peter Cohen, Director of the Centre for Drugs Research at the University of Amsterdam, has argued that Sweden's low level of drug use and repressive drug policy, rather than being causally linked, are in fact both merely expressions of its historically temperance oriented culture, noting that Sweden also has historically low levels of alcohol, tobacco and prescription drug use. It is also worth pointing out that Sweden has low levels of social inequality, social deprivation, and unemployment, combined with a very high level of health and social welfare spending. There's a lot to admire about Sweden, but even they can play drug-war politics.

* since publication of this article a new UNODC annual report has been published with the UNODC funding rankings shifting slightly (see page 89). Creeping into the number one spot for individual state donors, coincidentally in the year the glowing Sweden report is published, is.....Sweden (9%). The US slips to number two (8%) and straight in at number three is.....The UK, at 7% - a shade under 11 million US dollars. Bargain.

The first thing to say is that it's welcome to see a response from the minister, and whilst it comes across as tad defensive it hopefully points to a window of opportunity for some sort of engagement as the new drug strategy is being put together. Whilst definitely more engaged and marginally less waffly, a lot of the content in the piece is similar or identical Coaker's comments in this week's Drink and Drug news which I critiqued in detail here and don't need to be rehash. There are a couple of things that warrant comment however.

One is the way that again Coaker portrays Government policy as a reasonable compromise between two extreme poles:

"Too often the drugs debate is characterised by polarised viewpoints: those arguing for harm reduction versus those arguing for greater prohibition and tougher punishments for dealers and drug users. The drugs debate, however, is more complex, and I do not see this as an either/or issue."

In the Drink and Drug news version this had a slightly different slant:

"I am keenly aware the debate over drugs remains highly charged and the challenge for government is to navigate a way through competing demands. I fully understand the strong emotions involved; but too often the debate is framed in extreme terms – some people argue for legalisation while others argue for tough enforcement – leaving little space for a rational debate in the centre ground. For example, in recent months we have heard from people who think drug legalisation would be the answer to solving the social problems associated with drug misuse. On the other hand, I do not have to go far to hear from people who call loudly for even tougher enforcement against drug dealers and drug users."

I assume that the way 'legalisation' as extremism has morphed into 'harm reduction' as extremism is a mistake by whoever actually wrote the piece; the Government has been very clear in its support for (some) harm reduction initiatives (if less open about its role in creating those harms in the first place), and indeed Coaker expresses his support for harm reduction in the previous sentence. No, what is more odd is that Coaker is playing the navigating-between-extreme-positions card at the same time as perpetuating the entirely unevidenced policy of prohibition, a position that could only be described as extreme, involving as it does; mass criminalisation of 40% of the population and gifting control of multi-billion pound markets in dangerous drugs to violent criminal cartels (not to mention 40+ years of quite staggering failure).

I find it ironic that the figurehead of the horribly outdated, failed, and ideologically extreme policy of prohibition, would refer to a group calling for a greater public health focus and evidence based approach to drugs as 'extreme'.

For Coaker and the Home Office prohibition remains the elephant in the room. If they cannot acknowledge that the illegal markets prohibition creates are the significant driver of drug related crime and drug related harms, then any dialogue can only be a superficial one.

The other paragraph that jumps out at me is the second to last:

"Danny also recommended that we look to other countries - the Netherlands, Spain, Switzerland and Portugal among them - which adopt a public-health approach to tackling drug use. We can always learn from abroad, but we have to be wary of making assumptions and comparisons. Ultimately, each country has to tailor its own strategy appropriate to its history, traditions and culture, through open and honest discussion about the problems it faces."

The striking thing here is that the US does not get a mention. It is both the spiritual home of the enforcement led 'war on drugs', and also the role model for the UK's tough approach. Whilst the UK has arguably the worst drug problem in Europe, the US has the worst in the Western world. Perhaps this is no coincidence, yet still we choose to ape their approach, at least in terms of the political discourse, with our obsession with 'toughness' and all the the ludicrous trappings of zero tolerance; three strikes you're out, mandatory minimums, drug testing and sniffer dogs in schools, ever harsher sentencing, a ballooning prison population of non violent drug offenders, drug tsars - the whole shebang.

Coaker wants to have it all: the perceived political benefits of a tough talking 'war on drugs', as well a the real world benefits of a public health/harm reduction approach to drugs. Unfortunately he can't. A distinction needs to be made between harms related to drug use itself and harms created or exacerbated by the governments obsession with using criminalisation as its primary tool for managing drugs in society. If he can't do this then the genuine debate he claims to want will be anything but.

Thursday, May 24, 2007

Reading this post on the US based stop the drug war blog you'd be forgiven for thinking that certain cannabis users really don't do the drug any favours in the PR stakes (for the remainder of this post we will be referring to cannabis in the US vernacular: marijuana/pot) . One day in the life of the US, this Monday just gone as it happens, turned up the following sorry tales:

If you work at McDonald's, don’t hide your pot in a Happy Meal. Something bad will happen.

Don't drive drunk, especially if you've got 25 pounds of marijuana in your car. Seriously, you're off the team if you do that.

Operation Follow Method Man (the US rapper with a very public penchant for smoking blunts) has also produced unsuprising results this week: the arrest of Method Man for possessing marijuana and driving around wasted.

method man: less than 100% cautious

Stop the Drug War blog remain sanguine about all this pot related daftness:

In fairness to our cause, I'm not suggesting that marijuana necessarily causes idiocy. But it can become a crutch for the desperate or confused. As for the celebrities, well, it's already clear that celebrities don't exactly need pot to get arrested anyway. Method Man, notwithstanding this unfortunate incident, would probably get arrested more often if not for his frequent relaxation rituals.

Today was a strange day for marijuana news, but tomorrow will tell a different tale. Bad science, violent raids, urine testing, persecuting patients, blocking research, wasting tax dollars, exaggerating harms, and funding the black market; these things -- and so many more -- are the real story and there aren't enough mailing mishaps or celebrity pot busts to distract us from the hideous truth.

Wednesday, May 23, 2007

"Addictive behaviour seems to be inextricably linked with reward. The behaviour that the addicted individual performs has to reward them and there need to be plenty of opportunities to perform it too. However, this also describes many of the behaviours that human beings do every day – eating, working and sleeping, for example.

This New Statesman supplement explores what we are currently prepared to do to address the issues of addiction – and what we may need to accept in the future if we are to make any further impact on it."

the supplement features the essay from Transform introducing a round table on addiction discussion featuring:

Tuesday, May 22, 2007

As part of the ongoing development of the Transform Fact Research Guide, we have added a new section on drug prices in the UK. Here you will find the most recent drug price data from the main independent and official sources, along with some commentary and analysis.

The Fact Research Guide also contains headline data, links to key data sources, commentary and analysis on the following subjects:

We invite Home Office minister Vernon Coaker to give us insight to his approach to revising the Drugs Strategy. He explains his direction of travel.

This week I am looking forward to national tackling drugs day, a chance to celebrate the wonderful work that often goes on, often unsung, around the country. On Wednesday, groups in places as diverse as Camden, Durham, Blackburn, Milton Keynes and Ceredigion will highlight the dangers posed by drugs and the work that goes on to tackle this menace.

A drug treatment centre will be officially opened in Barking and Dagenham, there will be information stalls across the country and Gateshead will host a concert with a song, called ‘Kick It’, written and performed by a former drug user.

Whilst it is absolutely correct to celebrate the excellent work done by many drug service providers, what we have here is essentially an exercise in diversion. On numerous occasions we have seen politicians asked searching questions about drug policy only to completely ignore them and respond with a list of local initiatives like anti-drug songs at events in Gateshead.

On Wednesday drug action team partnerships will be organising events to support the day, from police crackdowns, information stalls in supermarkets, sports activities for young people to balloon releases to mark the numbers of people in treatment, and football and rugby matches featuring people involved in the effort to tackle drug misuse.

This from the Government that allows alcohol brands to aggressively market alcohol to children and young people through football, rugby and other sports sponsorship, despite the emergent alcohol related public health and social disorder crises that eclipse anything related to illegal drugs. Drug menace indeed.

In all, six ministers will be out and about, demonstrating just how much of a priority this government places on tackling drugs and reducing the harms they cause. I will be leading the ministerial activity by opening a new treatment centre in Barking and Dagenham. Alongside other ministers, I will be playing a football match against Lambeth North Positive Futures scheme and the Hull-based charity, Dads Against Drugs to launch the Tackling Drugs Changing Lives Awards 2007.

This smacks of doing keepy-uppey whilst Rome burns. Millions are suffering as a result of failing policy and the actively counterproductive effects of an enforcement led response to a public health problem. And our drugs minister is off to playing football to celebrate 'success'.

This isn’t just talk (no its waffle): since 1998, when we launched our ten-year Drug Strategy, this government has made tackling drugs a top priority. We have backed our strategy with unparalleled investment of over £9 billion in enforcement, education, early intervention, and treatment.

So, you've thrown loads of money at the problem. Good, but has it been effective? Unsurprisingly Coaker claims that:

We have spent this money well: overall drug misuse has fallen by 16 per cent since 1998 while the misuse of Class A drugs has stabilised.

As explored in another recent blog entry, this sort of claim is playing very fast and loose with the available statistics, which can easily be cherry picked and massaged to show success, even when the reality is somewhat different: Total Class A drug use appears stable because the fashions for ecstasy and LSD have moved on. But these, according to most analyses, are two of the least harmful Class A drugs - probably mis-classified by a couple of alphabetic increments. The two drugs the Government has repeatedly said it is most concerned about are heroin and cocaine, because they are responsible for the lion’s share of secondary crime harms – (that £16 billion a year in crime costs the Home Office keep mentioning). This is where the real enforcement push has gone, but these are also the two drugs where policy has fared the worst: having risen steadily and dramatically in the case of cocaine, or in the case of heroin, risen up until 2001/2 and then stabilised. There is no good way to spin this – a dramatic rise or stabilisation at a perilous and unprecedented high is NOT a policy success, especially when the key strategc goal of ten years ago – which literally billions of pounds has been thrown at - was a significant reduction. All the other ‘successes’, the marginal falls in ecstasy, amphetamine, LSD, cannabis use and so on, pale into insignificance next to this monumental disaster where it really matters.

I am particularly heartened that drug misuse among young people has fallen by over a fifth in the last ten years.

Again, as discussed elsewhere in the blog we can use the same tables to show that, for example, the proportion of 11 year olds reporting ever using drugs has risen by 1400% since the start of the drug strategy. Hardly cause for popping the champagne.

More and more people are entering and staying in drug treatment. Nearly four-fifths of the 181,000 people who underwent drug treatment programmes in the last financial year completed their programmes.

Process indicators again. Meaningful outcomes, such as the shockingly high reoffending rates, are completely ignored (because they are mostly very bad indeed). Throwing money at treatment services can easily give you good throughput numbers, but says nothing about outcomes. Coaker should be given an award from the cherry pickers guild.

Despite these successes, I am keenly aware the debate over drugs remains highly charged and the challenge for government is to navigate a way through competing demands. I fully understand the strong emotions involved; but too often the debate is framed in extreme terms – some people argue for legalisation while others argue for tough enforcement – leaving little space for a rational debate in the centre ground. For example, in recent months we have heard from people who think drug legalisation would be the answer to solving the social problems associated with drug misuse. On the other hand, I do not have to go far to hear from people who call loudly for even tougher enforcement against drug dealers and drug users.

Since Transform is the only organisation in the UK calling for legalisation and regulation I have to assume Coaker is, to some extent at least, talking about us. He mentions legalisation three times in this short piece, which I have to take as a promising sign that they are worried – they see the rational arguments for pragmatic moves towards regulated markets as a threat to the crumbling prohibitionist status quo. His response: to portray the position as an extremist one by equating it with the get tough enforcers, and then failing to engage with the critique of prohibition's failure or the detailed and nuanced debate about alternative policy, as espoused in Transform's (amongst others’) analysis.

Coaker's comments closely echo those made by Roger Howard a few weeks ago on 5Live, launching the new UKDPC:

“There are some very simplistic solutions put around. One argument is: let's legalise everything. Well we've only got to look at alcohol and tobacco, and the huge problems that are there. There is no simple solution there. The other school says bang 'em all up, put 'em away and throw away the key. That doesn't work either. We need to have a mature debate.”

These comments represent defensive positions that are based on undermining others who think differently. Ironically they actually entrench the perception that there is a polarised debate in the minds of the public, even though this reflects media rather than intellectual debate in this area . This is particularly galling for Transform given that this apparently polarised scenario is entirely different from that portrayed in our published materials, clearly unread by either Coaker or Howard. Moreover, Transform has recently been one of the founder members of the Drugs and Health Alliance – that, as part of its attempt to engage a 'mature debate' and attempt to navigate the 'centre ground' avoids the prohibition/regulation debate altogether. Furthermore, 'legalisation' is neither an ideological position nor an end in itself. It is a process of moving from the straight jacket of prohibition to flexible and responsive systems of public health-led regulation of different drug markets based on evidence of effectiveness. And thence to genuine attempts to address the underlying problems that lead to drug misuse.

Others will refer to drug policies abroad, whether in the Netherlands, Sweden or the United States, and say we should adopt the extreme policies of zero-tolerance or legalisation. Each country has to tailor the drug strategy that is appropriate to its own culture, history and traditions.

And out of the three countries mentioned the UK basis it policy on that of the one that is the most spectacular disaster: the US. And, not forgetting the Government’s desire to get tough on ‘causes’ of problems – it was the UK and the US who propped up the bottom of the league table of twenty one industrialised nations for child wellbeing in a recent UNICEF report.

But the truth is that any drug strategy cannot succeed without a comprehensive approach that focuses on enforcement, education, early intervention and treatment. Tough enforcement stops criminals and takes harmful drugs out of circulation;

No it doesn't – drugs are demonstrably cheaper and more available than ever before, not that Coaker would mention this widely acknowledged fact. Added to which, all the evidence-based analysis shows that it is the very enforcement of supply side prohibition that creates the gargantuan criminal drugs market and the wealthy gangsters who run it (See the Prime Minister's Strategy Unit drugs report 2003).

education empowers young people with knowledge of the harms caused by drugs; early intervention with vulnerable groups in order to prevent them from becoming drawn into drug misuse and treatment improves individual lives, and cuts crime and anti-social behaviour.

One sentence I wouldn't disagree with. Shame though that two thirds of the drugs budget goes into futile and counterproductive enforcement and interdiction efforts. The very initiative that serves to marginalize further the vulnerable groups that Coaker claims to be so keen on helping. Which leads nicely into the most shameless bit of spin in the entire piece:

Our latest figures show that more than 15,300kg of cocaine and 2,200kg of heroin were taken out of the supply chain in 2005/06. Almost 200 illegal criminal gangs were disrupted and £30 million of drug related assets were seized.

Coaker fails to mention here, of course, that the illegal drugs trade is created in the first instance by the UK’s commitment to global prohibition in the first instance. It is the futile attempt to eradicate production and supply in the face of rampant demand that has gifted one of the largest commodities trades on earth to organized criminals (again, see Tony Blair's Strategy Unit drugs report 2003).

That matters. I know, when I meet people in my constituency and elsewhere, that people want tough action on dealers, the people who drag down their communities.

Whilst I'm quite sure that Coaker's consituents care about dealing in their communities he is being dishonest and willfully misleading when he suggests the impressive sounding seizures and the number of criminal gangs disrupted will make the slightest bit of difference. Seizures have been consistently shown to be entirely irrelevant to overall supply, (which in an unregulated and highly profitable market, will always keep pace with demand, as has been explored numerous times on this blog). Drugs, as already discussed, are acknowledged - even by the Home Office - to be cheaper and more available than ever before, and suggesting supply side success in this context is, to my mind, the most shameless and deceitful of all the Home Office drugs spin. Supply controls have spectacularly failed by any reasonable measure and dressing this shocking and expensive failure up as success does the debate about 'what works' no favours at all.

However, as a former teacher I know that drug education has a significant role to play. We no longer wag the finger at young people and tell them simply not to do drugs. Instead, through the multimedia FRANK campaign, we empower young people by warning them of the harms caused by drugs and the risks involved with drug misuse, targeting vulnerable young people who are most at risk and providing specialist interventions for young people with developing drug problems. This approach has paid dividends with drug misuse falling among young people. After a decade of success, we are looking to renew our Drug Strategy and will shortly consult on the way forward for coming years.

If they already think, before any real review or consultation process, that the last strategy was 'a decade of success', what hope is there for any fresh ideas or real change?

I want to hear fresh ideas on how we can enhance the drug strategy, but I am clear that I want to focus on what works: enforcement, education, early intervention and treatment. In talking to drug treatment professionals it is evident to me that drug classification is important in setting out the legal framework for drug control. It has stood the test of time

Given the battering the classification system has taken by the Police Foundation, the Home Affairs Select Committee, Drugscope and Turning Point, the RSA report, Coaker’s own senior advisors published in the Lancet, and most devastatingly by the Science and Technology Committee last year – this comment about 'standing the test of time' is nothing short of risible. It also comes after John Reid rejected a review of the system, that had been recommended by everyone from the previous Home Secretary, the ACMD, various select committees, NGOs, indpendent policy commissions – in fact everyone who has ever been asked who is not Vernon Coaker or John Reid.

and I want to focus on the most important aspects of tackling drug misuse: how we can enforce the law against dealers and supplies; how we can empower our young people with knowledge of the harms illegal drugs cause; and how we can provide treatment most effectively so that even more drug misusers are treated for the benefit of them and their communities.

This strategy has worked and I want to enhance it. I remain fully committed to our strategy of enforcement, education, early intervention and treatment, focusing at all stages on harm reduction. Working together, we can reduce even further the harm caused by illegal drugs.

Rounded off with some tried and tested platitudes and repetition of existing policies.

I have to say this does not inspire confidence that the consultation process for the new strategy will be a meaningful one, or that anyone who suggests any change in the preordained 'direction of travel' will be listened to. If this is the level of engagement and honesty we can look forward to, we should all be extremely worried.

UK drug policy is unique. In no other area of social policy do we criminalise at one stroke both recreation and disadvantage. In no other area have we seen so much evidence of the counterproductive effects of a predominantly criminal justice response to a public health problem. And we have seen almost no genuine debate or evidence-based scrutiny from ministers. The last 10 years of this parliament's tacit and active support for a policy based on moral panic has finally broken the camel's back. As the Home Office reviews its last 10-year strategy - results are expected next month - the Drugs and Health Alliance has been formed to bring together organisations committed to bringing about a public health-led approach for the next decade.

In the mid-80s the Conservative government, in the face of a potential HIV/Aids epidemic, initiated a proactive harm reduction strategy that led to the UK having one of the world's lowest rates of HIV. It was based exclusively on a pragmatic public health and harm reduction approach to dealing with unsafe sex and injecting. No one suggested that we should ramp up penalties for injecting drugs or make unsafe sex illegal. How times have changed. Twenty years later there are significant political taboos among senior policymakers who dare question the prevailing tough criminal justice line on drugs. The result has been that most of the drugs initiatives in the last decade have had draconian law-making at their core.

Our current policy is completely at odds with social and legislative norms, a strategy based on criminalising drugs in order to reduce social harm. Yet, as the PM's strategy unit drugs report of 2003 showed, it is the very illegality of the supply and use of drugs that causes harm. Despite our commitment to harm reduction, drug use exists within a political and legal framework that is harm maximising; hepatitis C remains at 80% among injecting drug-users and HIV, while still very low, is on the increase.

Throughout the last decade government has shown a pathological unwillingness to debate the efficacy of the current approach. Witness the lack of genuine engagement with the Police Foundation drugs report of 2000, the Home Affairs Select Committee report of 2002, the Science and Technology Committee report on drug classification of 2006 and the recent RSA report, as well as the announced and then withdrawn public consultation on the drug classification system and the lack of consultation or parliamentary scrutiny of the Drugs Act 2005. The list is endless. One concern is that the upcoming consultation on the future of the UK drug strategy will end up looking strikingly similar to the last one.

The frustration of many working in the drugs field is that the obsession with crime reduction has overshadowed the need for improvement of individual and public health. We are demonising some of the most marginalised people in the UK rather than offering them effective treatment. For commissioners of services, this ought to look perverse and bizarre: enforce the drug laws in such a way as to increase the offending of problematic users of the most dangerous drugs, "identify" them through the criminal justice system and finally spend money on "treatment", as ordered by the court, as a way of reducing their offending. The £13bn to £16bn in crime costs associated with the current drug policy should suggest an urgent reallocation of the billions spent on counterproductive heavyhanded enforcement, toward education, dealing with underlying social problems and treatment in a primary care setting.

Ultimately, we need a new paradigm for drug policy development, one based around health and wellbeing rather than macho posturing and knee-jerk, short-term responses to the failures of the current criminal justice-based policy. The UK sits atop the rankings for levels of problematic heroin and cocaine use. The Dutch, Spanish, Swiss, Portuguese and numerous other nations have all adopted a more public health-focused approach. The average age of heroin users in the Netherlands is 40. They have half the rate of cannabis use compared to the UK. Isn't it time that we joined them?

The consultation on the new strategy offers a window of opportunity for change that will close again soon. This is our chance to let government know that tough enforcement does not reduce harm, it creates it. We should grab the chance with both hands.

Monday, May 14, 2007

Here's one we haven't seen before. Throughout the long history of reefer madness this one has to be the weirdest yet. A new short for MTV Canada, reported in the Toronto star attempts to dissuade young people from driving stoned. Itself a perfectly laudable goal, but the new ad's approach is to present an every day cautionary tale suggesting that your judgment after smoking a bong will be so compromised you will engage in a homoerotic kiss with your same sex sibling. And if you're so wasted you're snogging your brother, well obviously you really shouldn't be driving.

You'd be forgiven for asking what the hell this is about. I feel fairly certain that a search of Pubmed will show no papers linking cannabis and gay incest. No - this is a classic attempt at the modern art of viral Internet marketing. In terms of exposure, it clearly works - I'm blogging it, your reading about it and probably watching it, some of you will tell others about it, and on it goes. The film makers, none other than uber-agency Satchi and Satchi, are not a stupid bunch. They've thought this through; they know you can massively magnify an ad's exposure by including enough controversy or shock value to ensure the ad itself becomes the story. So far, so cynical.

But, you have to ask - will the ad, either in its original TV slot or in its Internet afterlife, achieve anything more than lots of viral exposure. The so-clever-it-hurts Satchi execs clearly know all about exposure, but do they know how to reduce the level of driving under the influence? Do they measure outcomes? Do they care? Anti-drink driving campaigns have been highly effective in the past, so its not as if the film makers had nothing to base this pathetic effort on.

The obvious problem with the film is that it's completely ridiculous, and fails so spectacularly to chime with reality or the experiences of its target audience that the possibility then exists of its safe driving message actually being undermined. 'Kids' don't like being patronised, and we have long and rather tragic history of failed anti-drug campaigns devised by 'grown-ups' to prove it.

Thursday, May 10, 2007

Hello and thanks for your continuing support of the Transform Blog, which continues to go from strength to strength. We nudged 6000 unique visits and 10,000 page views last month, which is pretty good for a super-niche blog with no budget that is less than a year old.....

Half the Transform team are off to Warsaw next week for the International Harm Reduction Association annual conference , which for the first time ever is holding a plenary session on regulated drug markets (facilitated by Transform director Danny Kushlick). So blog activity may be a bit slower than usual, although we will try and post some conference updates and news if there is a spare moment.

In the mean time there are still a few technical/housekeeping issues with the blog, regarding updating the tags and sorting out the feeds, so thanks for your patience - and keep on sending your interesting news and comment ideas.

Wednesday, May 09, 2007

.Having been away for the Bank Holiday I had the pleasure of not having having my Sunday sullied by to read the latest installment in the Independent on Sunday's six week born-again war on cannabis (covered extensively elsewhere in the blog), with all its misrepresented statistics, sensationalism, misunderstanding of public health policy and lazy drug-panic journalism.

It was therefore with some trepidation that this morning I reluctantly tapped 'cannabis' into the Independent website search engine to see what would pop up. What would it be this week? Having already recycled most of the usual reefer-madness material from the past few decades (super-strong genetically modified Franken-pot that will make you into a violent, insane, heroin addict with cancer etc..) the only territory left was getting increasingly obscure; infertility, teenage boys growing breasts, mutant six-toed canna-babies, psychotic skunk-zombies storming the IOS offices?

In 2005 the White House Drugs Czar, John Walters, claimed success in the ‘War on Drugs’, on the basis that cocaine prices were increasing and quality falling - clear indicators of a reduction in supply. A reduction in supply can be caused by a number of factors, but the Drugs Czar claimed it as an enforcement success, perhaps foolishly in retrospect, given that any change in fortune might correspondingly be held up as a failure.

As Transform point out in their soon to be published handbook “After the War on drugs, Tools for the Debate”:

‘never let anyone claim that supply side enforcement is effective without a very robust challenge – the evidence against this assertion is clear, overwhelming and acknowledged by all credible sources, official and independent’.

Apparent short-term successes often mask longer-term trends. They can also be due to (non-policy related) external factors, changes in statistical collection or methodology, and sometimes a marginal change can be within statistical error parameters. This sort of cherry picking can be countered by bringing the focus back to the bigger picture statistics on the failure of the policy nationally and internationally (be careful to make sure the blame is on the policy makers, not those who are implementing policy– the police do their job as best they can, it just happens to be an impossible one). Also remind policy makers that it is the policy of prohibition that created the crime and illegal markets in the first place’.

In a recent report, The Washington Office of Latin America demonstrates that the ‘gains’ of 2005 were short-lived. They say “preliminary U.S. government data, quietly disclosed by ONDCP, indicate that cocaine’s price per pure gram on U.S. streets fell in 2006, while its purity increased”. They also note that this is the continuation of a 25-year trend:

Not that UK policy makers will broadcast the fact or publicly admit that international supply side drug enforcement has been an abject and total failure. Indeed the Strategy Unit report, repleat with inconvenient truths, remained resolutely unpublished until partially released under FOI pressure in 2005 and then leaked in full to the Guardian the following day.

You would also be hard pushed to appreciate the scale of the failure from the laughably misleading cherry-picked propaganda that the Home Office publishes under its list of drug strategy 'successes' on drug supply and availability (in which the above graph most certainly does not appear). It’s all somewhat at odds with the Prime Minister's 2003 report that concluded unambiguously that

“Over the past 10-15 years, despite interventions at every point in the supply chain, cocaine and heroin consumption has been rising, prices falling and drugs have continued to reach users. Government interventions against the drug business are a cost of business, rather than a substantive threat to the industry's viability”.

As we approach a key juncture in UK drug policy with the new drug strategy being formulated, this sort of spin and misleading data does no one in domestic or international policy making any favours. Running away from the truth because it is politically risky will only lead to the further entrenchment of failed and counterproductive policy, and a supply side drug strategy as expensive and disastrous as all the previous ones.

.Commissioned by the Open Society Institute Law and Health Initiative, this research paper reviews jurisprudence from treaty-monitoring bodies of the United Nations and selected regional and national human rights courts that can be used to advocate for the human rights of people who use drugs.

Friday, May 04, 2007

Another long lost classic from the Anti-Drug archives. Watch out for Chuck, the sharp-suited drug peddler, who leads the helpless young victim from reefers to helpless heroin addiction and depravity in a couple of weeks.

Things have improved, a bit, on the drugs education / prevention front since then, but it has been 50 years so you would hope so.

While military operations authorized by incoming President Felipe Calderon of the National Action Party (PAN) have led to arrests and drug seizures, they appear to have had no substantive impact on the multi-billion dollar a year business of supplying Americans with the illegal drugs they demand.

Now, as the nation ponders a fundamental reform of the government itself, the leading opposition party, the Party of the Democratic Revolution (PRD) is calling for a National Agreement to Combat Organized Crime (read: the drug trade), which would include discussion of legalizing drugs.

The first rumblings came in the middle of last week, when Javier González Garza, the PRD's legislative coordinator in the Assembly, called for an end to the drug war. The endless war against the so-called drug cartels is fruitless, he said in an interview posted on the party web site.

Javier González Garza

"I believe that we cannot continue with this affair thinking we are going to combat the problem of the drug traffic without more radical measures," said González Garza. "One of these has to be the legalization of drugs in the United States. Then, we could begin to change things. Those military operations during this presidency, it's obvious that they are not obtaining results. I think that the US is the largest market and because of that, there is where we can achieve an international accord where we can pass to the next level, to legalize the consumption of certain types of drugs, and then eliminate this type of thing that is happening. That's one part," he said.

"The other part has to do with being able to think of other actions," González Garza continued. "This war, as it is now conceived, will cause us to lose everything; it doesn't make any sense. There have to be changes in that."

Then, last Friday, PRD Sen. René Arce Islas, secretary of the Senate's Public Security Commission, proposed the "National Agreement to Combat Organized Crime," including drug legalization. Ending drug prohibition is controversial, but reasonable, said Arce. "Evidently, that is a radical action that generates much controversy, but if we analyze it with maturity and serenity, evaluating the pros and cons, the risks and potential benefits, you cannot discard being able to arrive at an agreement that would, from our point of view and many specialists, do away with the drug traffic and the delinquency that accompanies it."

Sen. René Arce Islas

The PRD and its allies control 157 seats in the 500-seat Assembly, while the PAN controls 206, and the party of the former "perfect dictatorship," which ruled Mexico for seven decades, the PRI, is reduced to third place with 106 seats. In the last legislative session, a bill that would have decriminalized drug possession in Mexico was on the verge of passage when pressure from the United States caused then President Vicente Fox to back away. Will another year's worth of drug prohibition-related horrors lead to a different result this time around?

Tuesday, May 01, 2007

Our criminal justice approach to drugs has failed. The priority is public health, says new alliance of drug charities

A new Alliance of drug charities launches today in London, calling on the Government to put public health, harm reduction and tackling poverty and exclusion at the heart of UK drug policy.

The Drugs and Health Alliance (DHA) is a group of organisations and individuals who support an evidence-based, public health-led approach to dealing with illegal drugs. An overwhelming body of evidence shows that the criminal justice-led approach to illicit drugs at home and abroad increases harms associated with their production, supply and use, whilst public health-led approaches consistently reduce harm. For many years there has been reluctance from the voluntary sector to criticise policy, because of their reliance on government funding; problems that are perpetuated by the Government’s failure to conduct an evidence-based review of the progress of the UK drug strategy and its failure to consult with informed public opinion.

In 2007, the UK ten-year drug strategy comes to an end and a window of opportunity opens. DHA supporters want to be included in the policy development process to assist in putting in place an effective strategy for the next decade.

“Ten years ago the Government brought in an ex police officer (Keith Hellawell) as drug czar, to head up the UK drug strategy. A decade down the line, the evidence of the failure of our enforcement-led approach is all too apparent. In no other area of policy-making would we dream of criminalising recreation on the one hand and disadvantage and distress on the other. DHA is calling for the upcoming drug strategy to reallocate resources away from enforcement and towards a public health approach to drugs. It is truly criminal that the Government has not seen fit to publicly audit the enforcement approach to drugs and compare it with health interventions.”

"This government's first war was a war on drugs – one that rumbles on with a growing role call of casualties. The mistake was to move responsibility for drugs policy to the Home Office rather than the appropriate health agency, and to downgrade health targets whilst focussing almost exclusively on crime reduction. It's time to refocus drugs policy, and get back to dealing with the evidence of what works at reducing harm for users and the wider community."

“The UK has one of the highest drug problems per head of population in Europe. It’s therefore crucially important that any new strategy recognises the causal factors of poverty and exclusion as an integral aspect that we must address if we are to make a substantial impact on the problem in the years ahead.”

Martin Blakeborough (Director Kaleidoscope Project and member of the Advisory Council on Misuse of Drugs) said:

“Kaleidoscope believes the health of drug users must be the priority and therefore welcomes the launch of DHA. It is clear that in the past ten years the priority has been community safety at the expense of the basic health care and human rights of illicit drug users. The upcoming review of UK strategy provides the opportunity to change this.”

“It is becoming increasingly apparent that more and more mainstream groups now readily accept that many of the harms associated with illicit drug use are in fact caused or exacerbated by the present legal system, rather than the drugs themselves. The ‘crime reduction agenda’ has meant that civil liberties and public health have increasingly taken a back seat in drug policy. It is time for a change.”

“The Alliance is proud to be a partner, supporter and contributing member of the Drugs and Health Alliance. The Government's 10-Year Drug Strategy and its continued focus on the target-driven criminalisation of drug use and drug users, has only proved to increase the harm, stigma and alienation experienced by one of the most marginalised sectors of our communities. We welcome the work of the DHA and call for a pragmatic, non-discriminatory, evidence based drug policy that reestablishes the holistic health and social needs of the individual drug user as its core objective.”

“As a public health practitioner the launch of DHA is very welcome as the public health community has long realised that the only sensible approach to drug misuse policy is one which involves a public health perspective and framework rather than a repressive criminal justice one. I am confident that the Alliance will make a real difference to how drug misuse is regarded and dealt with in this country."

“Plymouth Public Health Development Unit is pleased to be contributing to the DHA. We welcome the inclusive approach the DHA represents and look forward to a time when some of the most marginalised and stigmatized groups in our communities can enjoy sustainable well being. The Public Health approach which the DHA embodies gives a real opportunity to deliver drug policy based on sound evidence rather than fear and prejudice.”

“The 10 year strategy has brought important improvements but leaves much undone. For a supposedly 'evidence-based' drug strategy we have a dearth of evidence. There is an urgent need to examine and evaluate more progressive approaches to preventing drug problems that move beyond the current, crude enforcement approach. At the same time, we need to strengthen and refine the assorted harm reduction-based treatment approaches that have been shown to work."

Notes to editorsMedia contact: Danny Kushlick 07970 174747

For further info:www.drugshealthalliance.netMember organisations:The Alliance, the Beckley Foundation, the International Harm Reduction Association, the Kaleidoscope Project, Release, Transform Drug Policy Foundation, the Socialist Health Alliance, Plymouth Public Health Development Unit and the UK Harm Reduction Alliance.

Individuals:Dr Brian Iddon MP, chair of the All-Party Parliamentary Drugs Misuse Group and a member of the Science and Technology Select Committee.

Drugs and Health Alliance Consensus Statement

The Drugs and Health Alliance is a group of organisations and individuals who support an evidence-based, public health-led approach to dealing with illegal drugs. An overwhelming body of evidence shows that the criminal justice-led approach to illicit drugs at home and abroad increases harms associated with their production, supply and use, whilst public health-led approaches consistently reduce harm.

For many years there has been reluctance from the voluntary sector to criticise policy, because of their reliance on government funding; problems that are perpetuated by the Government's failure to conduct an evidence based review of the progress of the UK drug strategy and its failure to consult with informed public opinion.In 2007, the UK ten-year drug strategy comes to an end and a window of opportunity opens. DHA supporters want to be included in the policy development process to assist in putting in place an effective strategy for the next decade.

1998-2007 An overwhelming criminal justice approach:

Prioritisation of crime reduction over harm reduction

Over-reliance on enforcement as a route of entry into treatment has operated to the detriment of many problematic users

Enactment of Drugs Act 2005 and Serious and Organised Crime Act 2005

Commitment to inflexible and outdated UN Conventions on Drugs and harshly enforced domestic drug laws has created and exacerbated harm

The consequence of which is punishment and stigmatisation of some of the most vulnerable and excluded members of society

2008-2017 Putting health first:

Drugs are a complex international, social issue that demand a strategic management approach, not a blunt criminal justice one. We believe that a comprehensive, joined up approach to drug policy development and implementation can only be realised if the drugs brief is taken out of its almost exclusive position in the Home Office, enabling us to develop a policy that is truly cross-departmental and placed within a public health framework. This shift would:

Put public health and harm reduction at the heart of UK drug policy

Facilitate the development and implementation of evidence based strategies that are more effective at reducing harm

Deliver improved value for money on drug strategy budgets, as measured against key public health and criminal justice indicators

Reduce health inequalities and, by extension, reduce deprivation, improve life chances and reduce offending (all of which are Home Office objectives)

Reduce some of the counterproductive effects of the international and domestic drugs enforcement strategy

This would, in turn:

Improve public health outcomes and protect the human rights of drug users

Enable us to better address the social issues that underlie most problematic use

Encourage effective efforts to reduce the progression from use to problematic use

Direct resources into helping some of the most vulnerable and excluded members of society

DHA is calling on Government to;

Prioritise public health goals

Implement a truly cross-departmental, public health-led strategy and place the lead role in the relevant health agencies

Commission an independent audit of outcomes against expenditure comparing public health with criminal justice approaches

Hold an official cross-departmental consultation on the efficacy of criminal justice and public health approaches

Reallocate drug strategy expenditure from criminal justice to public health

DHA also calls for:

A quadripartite select committee to be convened to conduct an enquiry into UK and international drug policy, the National Audit Office to conduct a value for money study of enforcement outcomes and the Advisory Council on the Misuse of Drugs to review the drug strategy and suggest reforms.

What we plan to do:

The DHA will produce briefings and discussion documents, hold seminars and brief policy makers, press and voluntary sector organisations on the benefits of an evidence-based, public health-led approach to dealing with drugs.

What you can do:

Join the DHA by signing up your organisation to thegrowing list of members - This can be done by contacting the DHA Secretariat on (0117) 941 5810.

Become active within your field by campaigning for, and promoting the work and goals of the DHA.

This blog has many contributors; blog entries or comments posted to blog are not necessarily the views of Transform Drug Policy Foundation. For official comment or position statements on any given topic, or with any feedback or queries, please contact Transform. Transform Drug Policy Foundation is a registered charity No. 1100518